How robots are helping children with autism

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autism, body movements, chest monitor, Children, classroom, communication, early diagnosis, emotion, facial expressions, family, feedback, interaction, modes, motions, non-threatening, non-verbal communication, reactions, research, robot, social interaction, social skills, teacher, therapist, treatment, withdrawal

How robots are helping children with autism

Anthony Arceri is seven and has autism. His clothes are covered in sensors, and he is standing in front of Zeno, a smiling, 2ft-tall robot. “What is your favourite food?” Zeno asks Anthony. “Chocolate milk and french fries.” “I love chocolate milk,” Zeno replies. The robot raises its arm, and Anthony copies. Zeno rubs his stomach, and so does Anthony.

It looks like fun – and for Anthony, it is. But researchers believe the interaction between Anthony and the robot also holds the key to early diagnosis and treatment of autism. Zeno is the result of a collaboration between Dr Dan Popa at the University of Texas at Arlington, Hanson RoboKind, Dallas Autism Treatment Centre, Texas Instruments and National Instruments – and is the brainchild of Hanson Robot owner and former Disney imagineer David Hanson.

Diagnosis of child autism has traditionally taken place through social interaction and speech exercises. This means that, until a child can speak, diagnosis is either a lengthy process, or can’t happen. But Zeno can interact with children through nonverbal communication such as body movements and facial expressions, speeding up diagnosis and perhaps even enabling it to be carried out before a child can talk.

Zeno isn’t just used for diagnosis. Children with autism can sometimes find social interaction threatening – making them withdraw, even from family members. Robots such as Zeno have features that look slightly human, but are obviously not human. This makes communication, with all its complex and frightening subtleties and nuances, less complicated and more comfortable for the child.

Anthony’s mother, Pamela Rainville, found out about Zeno from the Dallas Autism Treatment Centre, and thought the project might benefit Anthony. “It’s always good for him to be put in different situations, things outside his normal routine. Anytime he can be around other people, it’s a good learning and growing experience for him.”

So far, Anthony has had two therapy sessions with Zeno. Rainville believes he got more out of the second meeting than the first, and she expects he will get even more out of subsequent interactions with the robot. “This second time, Anthony fist-bumped Zeno, which was great. It shows he was a little more relaxed.”

Popa believes that Zeno is a good motivator for children as he is engaging and non-threatening: the children listen to the robot. “The idea is for the robot to instruct kids, give them some useful social skills and at the same time observe their reactions and calculate their reaction times. That calculation could form some kind of an autism scale.”

He says there are three ways in which therapists can use Zeno. “The first mode is called a scripted mode of interaction, where you pre-programme a certain sequence of motions. For the second mode, we have added a control system so we can have an operator or therapist control the robot by tele-operations. In this mode, it mirrors the motions of the instructor.”

In the third mode, the child can take control of the robot. “This can be unsafe as the child can do things – such as slap himself – that the robot will copy and possibly break. So we tend to use this third mode as entertainment only.”

Zeno now has a brother, Milo, as well as an international family. Zeno came first, and is used in research and classroom settings. Milo was created specifically to work directly with children. According to Richard Margolin, director of engineering at Hanson RoboKind and part of the team who developed both robots, some children with autism who had never spoken directly to an adult teacher spoke to Milo.

Milo looks very similar to Zeno. His expressive face is an important feature, because a characteristic of autism is the inability to read and connect with the emotions of others. Children are asked to identify the emotion shown by Milo from multiple choices on an iPad. Milo’s eyes are cameras, recording feedback. The child wears a chest monitor that records changes in heart rate and therefore emotion. A typical lesson would involve Milo and a child interacting one-to-one; the child responding to the robot with an iPad, and a therapist or teacher present to help if needed and record difficulties and progress.

One of Zeno and Milo’s international relatives is Kaspar, designed in the UK by the University of Hertfordshire’s Adaptive Systems Research Group. The size of a small child, unlike Zeno and Milo, Kaspar has a neutral expression so that children can interpret him how they wish. Research is under way to see how Kaspar’s use could support children with other developmental conditions, such as Down’s syndrome or attention deficit hyperactivity disorder, known as ADHD.

Another distant cousin is Nao, who was created in 2006 by Aldebaran Robotics and is being developed as a “house robot”. Along the way, Nao has been used as an educational tool, and the University of Birmingham’s Autism Centre for Education and Research worked with Aldebaran Robotics on a version of Nao to help children with autism. But like Kaspar, Nao has an expressionless face.

What seems to be unique about Zeno and Milo is the way that their expressiveness defies long-held robotic conventions. Designed to be the first advanced social robots in the world, they could eventually have an impact far beyond the diagnosis and treatment of autism. RoboKind envisages a broader role for its robots in educating young children. In the words of his creators, Zeno represents the future of robotics and could be “a wonderful addition to every household”.

Social workers need training to help them better understand self-harm

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autism, awareness, education, family, online support, physical health, self-harm, social workers, support, training, understanding, young people

Social workers need training to help them better understand self-harm

It is estimated that one in 12 young people have self-harmed at some point in their lives, according to charity YouthNet. The charity says 3,000 people aged 16 to 25 visit its digital support service TheSite.org every month after looking up self-harm on a search engine. Yet, despite these statistics, self-harm awareness training for social workers is not always as comprehensive as it could be.

Nushra Mansuri, professional officer (England), at the British Association of Social Workers (BASW), says while some social workers – such as those working in mental health – may be sensitive to the issue of self-harm, there needs to be more awareness of the problem within the profession and that self-harm training is patchy.

“Whatever client group you work with, it will be a feature – it [self-harm training] should be integral because you are working with people whose lives are in crisis – there is a high correlation between the people you work with and people with a propensity to hurt themselves,” she says.

“Social workers need a greater awareness of the issue and need to understand why people self-harm. I wouldn’t lump everyone together, but it can be the impact of trauma, it can be a cry for help, it gives someone, who may have had control taken away from them, a sense of control.”

What mistakes could a social worker who lacks awareness of the issue of self-harm make? “An untrained person may have a tendency to look at the superficial and not go beyond that,” Mansuri says. “A social worker may be out of their comfort zone and not be able to deal with it – dealing with someone’s raw pain is really hard.”

Mansuri adds that social work “doesn’t have all the answers” when it comes to self-harm and that more education is required. “There is an underestimation of the importance of looking at self-harm,” she says.

Jennifer McLeod, managing director of self-harm training provider Step Up! International, says in some regions self-harm training for social workers is inadequate.

“Social workers ought to be trained in spotting the signs; if they aren’t spotted, it could be fatal,” she says. “It’s about listening to what’s not being said, looking for physical signs and emotions – they [people who self harm] are generally hiding something.”

McLeod adds that well-trained social workers will broach the topic with the young people and their families. “There might be denial from parents and social workers will have to find ways of eliciting information from young people.”

McLeod says delegates at Step Up! International training courses are often in a state of panic about the issue as they are uncertain about how to deal with the problem or even broach the subject.

“Some professionals don’t feel confident about bringing up the issue directly, they daren’t ask about it as they think it might make it worse”, she says.

McLeod suspects self-harm is on the increase – and is being talked about more – because of the current economic climate.

“In addition to the emotional and biological changes [young people experience], there is the recession, labour market issues, parents being made redundant – parents may not be managing and may be economically struggling,” she says.

Caroline Hattersley, head of information, advice and advocacy at theNational Autistic Society (NAS), says people with autism face a “raft of challenges” that might make self-harm more likely.

“Autism does bring specific difficulties – we’d like to see more training on understanding autism and its relation to self harm,” she says. “The key is understanding the individual and understanding the underlying causes.” Lacking this understanding could lead to a social worker misinterpreting why someone is self-harming, Hattersley adds.

“The individual might not have done it before, they may be hitting their head because they may have communication difficulties and they’re trying to communicate a physical problem – you might miss an ear infection,” she says.

Hattersley acknowledges that it can be difficult for professionals to admit they are struggling with the issue of self-harm. NAS has set up Network Autism, a forum where professionals can read research, and discuss with each other, the issue of self-harm and how it relates to people with autism.

YouthNet’s chief executive Emma Thomas says all practitioners working with people who self-harm would benefit from a better understanding of the problem. She adds: “If social workers are more aware of services like TheSite.org, many more young people can be directed to safe, anonymous online support to complement the vital offline support they need.”

Culture: Diverse diagnostics

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autism, culture

Culture: Diverse diagnostics

In rural South Africa, young children may look at adults’ faces while having a conversation, but they don’t usually make direct eye contact because it is considered disrespectful. Yet a lack of eye contact is a hallmark of social deficits in people with autism, and as such it is something Western clinicians look for when diagnosing the disorder.

There are other examples of children’s behaviour — such as finger pointing to draw attention to something, or conversing with adults as if they are peers — that are commonplace in the West and included in tests of autism.

“Most autism research originates in the West, and we have a particular view of what autism is, a particular view about how children behave and interact with adults,” says Courtenay Norbury at Royal Holloway, University of London, who worked with children with autism from ethnically diverse backgrounds in east London¹. “Other cultures might have very different expectations of how children behave.”This viewpoint makes it challenging to use behavioural diagnostic tests for autism in places where the disorder may look — and even be — different from in the West. But with growing interest in autism’s true prevalence worldwide and the need for autism services in poor countries, researchers are grappling with the best ways to objectively diagnose the disorder.Parent support groups for autism exist in more than 100 countries. “We know that autism is diagnosable and observable across cultures,” says Mayada Elsabbagh, a researcher at McGill University in Montreal, Canada, who is leading a group within the International Society for Autism Research on cross-cultural issues. “But the exact details of how different cultures or settings modify autism is unknown,” she says.

For many years, the relevance of culture to autism was ignored. Some researchers believed that autism was intrinsically linked to modernity and Westernization, and was rare in other cultures. Others assumed that because autism is a neurobiological disorder, its expression should be the same everywhere².

But many researchers are beginning to take a subtler point of view. “While autism itself, the neuropathology of it, may not be culturally determined, our interpretation of those behaviours and our response to those behaviours is,” says David Mandell, associate director of the Center for Autism Research at the Children’s Hospital of Philadelphia in Pennsylvania.

Diagnostic differences

Before they can assess autism worldwide, researchers must measure how often various behaviours occur in different cultures and establish the norm, says Charles Zaroff, a psychology researcher at the University of Macau in China. They will also need to work with parents of children with autism to identify how it might manifest in a given culture.

In many Asian cultures, for example, children are expected to express respect for their elders through their language and behaviour, but these aspects of social interaction can be tricky for children with autism to master. Such difficulties would hardly be noticed in much of the West. “Lacking that deference would appear completely appropriate in the United States, but that lack of attention to the strata in society based on age would appear very abnormal in places like China,” Zaroff says.

Because the most widely used screening tests for autism were developed in the United States and the United Kingdom, researchers are finding that they have to adapt the tests to identify autism in other countries. For example, part of the Autism Diagnostic Observation Schedule (ADOS), one of the gold-standard diagnostic instruments for the disorder, involves observing a child having a pretend birthday party — singing ‘Happy Birthday’, cutting and distributing slices of cake, and so on. But in rural areas of South Africa, birthdays often aren’t celebrated, so even typically developing children might be unfamiliar with this ritual.

So, for a study of early autism diagnosis in KwaZulu-Natal province, researchers developed an alternative scenario of shared excitement, involving a traditional African song. “It’s finding the intention of what you’re trying to elicit, and then finding an alternative,” says Amy Wetherby, director of the Autism Institute in the College of Medicine at Florida State University in Tallahassee, who led the work.

Wetherby developed a list of 22 early signs of autism based on studies of several hundred children in Florida. Unpublished data from 19 children show that many of the same red flags differentiate children with autism from their typically developing peers in South Africa as well, says Wetherby.

“The amazing part to me is the unusual gestures,” says Wetherby. For example, rather than pointing or looking together at an object, children with autism in the United States may communicate by taking an adult’s hand and moving it to the object. “That’s an early sign of autism, and we see that [in South Africa] as well.”

One reason the patterns of autism symptoms appear to be similar across cultures may be that the participants in this study are only 18–36 months of age. “The earlier we go,” Wetherby says, “the more similarities we will see.”

More culturally specific or environmentalsymptoms of autism may emerge as children grow up. For example, according to one recent study, 5–12-year-olds with autism in the United States are more sensitive to sights and sounds than are children with autism in Israel — although the authors note that genetic, cultural and environmental factors might be an influence, as well as the parents’ reporting of their child’s behaviour³.

Subtle speech

If cultural differences emerge later in childhood, this could further complicate the diagnosis of autism. The disorder tends to be diagnosed later outside the United States and Western Europe, in part because of a lack of awareness of both developmental norms and autism. A parent who notices that a child is withdrawn or has a language delay may not recognize that as a symptom of autism.

In-depth interviews in Goa, India, show that the parents there aren’t attuned to early social and communication milestones, and they usually become alarmed only when a child starts preschool and has trouble connecting with peers⁴. “What really concerns the parents initially is, ‘he’s not fitting in with everybody else’,” says Gauri Divan, a paediatrician working with the child health organization Sangath in Goa.

In some cultures, parents may notice symptoms that are not typically associated with autism. Among Latino migrant workers in Florida, for example, “the first complaint seems to be that the child is a picky eater,” says Roy Richard Grinker, a George Washington University anthropologist in Washington DC, who is collaborating with Wetherby on a study of autism in this community. “But then, if you go into more detail, you start to see that these children the mothers are describing are probably going to fall on the autism spectrum.” Grinker speculates that these mothers are particularly aware of eating habits because they are poor and food is scarce.

Some evidence suggests that doctors need to be trained to spot the signs of autism from oblique comments made by parents. For example, Mandell says, white parents in the United States often emphasize a child’s lack of communication by saying, ‘my child doesn’t respond when I call his name’, while black parents tend to use phrases like ‘my child won’t mind me’. Doctors may be less apt to consider a diagnosis of autism when they think a parent is describing a disobedient child rather than a socially impaired one — possibly helping to explain why autism is diagnosed less frequently among black children.

Raising rates

If parents in different cultures developed the same sense of autism awareness as in the West, research suggests, autism prevalence around the world might look no different to — or may be even higher than — in the United States or the United Kingdom.

Perhaps the most dramatic demonstration of this is a study of more than 55,000 children in South Korea, which estimated autism prevalence at 2.64% (ref. 5). That’s more than twice the autism prevalence in the United States estimated by the US Centers of Disease Control and Prevention, and more than 50 times higher than the South Korean government’s figure for autism prevalence of 0.046% (ref. 6). One reason for that higher estimate may be that the researchers screened children in the general population for autism symptoms, rather than recruiting them only from clinics for autism and other developmental disorders.

In South Korea, researchers suggest that one reason for the underdiagnosis in autism may be that the stigma attached to the disorder is particularly strong in that country⁷. The diagnosis of a Korean child with autism diminishes the marriage prospects of siblings, and it can even affect his or her parents’ careers. Parents often prefer that their child be labelled as having ‘reactive attachment disorder’, or ‘lack of love’ as it’s known in Korean, a diagnosis that affects the mother’s reputation.

Still, about two-thirds of the children the South Korean study identified as having autism attended mainstream schools and were not receiving any autism-related services. This widespread mainstreaming raises the question of whether a Western-defined autism diagnosis is meaningful if children are able to function reasonably well in their cultural context. “That’s an interesting issue,” says Norbury, who questions “whether we should be worried about these kids, and whether we should be making families worried about them, if there wasn’t any kind of worry before.”

Other children identified in the study may be what Koreans would call a ‘border child,’ a new term that is emerging to describe some who would probably be diagnosed with autism in the West⁷. “This is a child who is high-functioning enough to be in a mainstream school, but who has significant social impairment,” Grinker says. Parents prefer this label, he says, because it implies that the child is only impaired socially, not intellectually, and that the condition is temporary.

In stigmatizing autism, South Korea is not unique. But Elsabbagh points out that attitudes towards a disorder often change as more resources and services become available. That, she says, is one powerful argument for more cross-cultural research on autism.

Another is that it will advance understanding of the biology of autism. “We’ve constrained our participant pools to those of European ancestry, and we have also not considered very thoroughly some of the cultural determinants that may shape autism in different ways,” says Elsabbagh. “Taking a more global perspective would allow us to see that underlying commonality much more easily.”

References

1. Norbury, C. F. & Sparks, A. Dev. Psychol. (published online 5 March 2012).
2. Daley, T. C. Trans. Psychiatry 39, 531–550 (2002)
3. Caron, K. G. et al. Am. J. Occup. Ther. 66, e77–e80 (2012)
4. Divan, G. et al. Autism Res. 5, 190–200 (2012).
5. Kim, Y. S. et al. Am. J. Psychiatry 168, 904–912 (2011).
6. Kang-Yi, C. D. et al. J. Autism Dev. Disord, (published online 22 June 2012)
7. Grinker, R. et al. Autism Res. 5, 201–210 (2012)

How would it feel if you couldn’t recognise your own family?

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'face blindness', Alzheimer's, autism, brain impairment, brain injury, Children, dementia, face processing, facial perception, Memory, new national centre to study, parents, prosopagnosia, stroke, treatment

How would it feel if you couldn’t recognise your own family?

Imagine waking up and not knowing who’s sharing your bed. Imagine collecting a child from school – but picking up the wrong one. Or being a mother and not being recognised by your own child. These are all the problems faced by around a million people in the UK today. Among the famous sufferers are Duncan Bannatyne of Dragons’ Den, playwright Tom Stoppard and Jane Goodall.

It’s called face blindness – or prosopagnosia. It affects more people than Alzheimer’s and autism and, just like dyslexia before it, it’s a hidden handicap that gets people in trouble every day.

But a new national centre to study the condition has been established and pressure is building up on the NHS to recognise the condition and to get the public to understand it and sympathise with the sufferers. There’s also pressure for children to be tested because, after an experiment in Australia there may be hope of treatment. There, in Sydney, an eight-year-old boy identified only as “AL” was put through a long series of tests using grey scale photographs to retrain his brain. For the first time psychologists here are hoping there might finally be a solution. In a letter to the British Medical Journal Dr David Fine, himself a sufferer, revealed the torment of his early life. He wrote that the condition “has shaped my life”. He added: “I often fail to recognise my children or even my wife.” The doctor, from Southampton, is calling for a simple children’s test “so that the next generation of sufferers grows up in a society that understands and recognises our disability”.

Leading researcher Dr Sarah Bate, of Bournemouth University, also wants to develop a way of training sufferers with the condition. She’s just got funding to start a new national centre to study prosopagnosia and she’s already been contacted by 700 individuals offering to be tested. A number of parents who think their children might be sufferers have been in touch and now a joint project with the University of St Andrews is under way – the first attempt to improve these children’s skills at face processing.

Bate has found that part of the problem is the British tradition of wearing school uniforms. She says: “We had one boy of five and the only friend he could make – simply because her face was different – was a Chinese girl.”

In the United States, where they don’t use school uniforms, there was no such problem. And some children, she found, couldn’t even recognise their own parents. One teacher with the condition only coped by the use of seating plans. But when the pupils played up by swapping seats he got depressed and got a post at the Open University corresponding by email.

Dr Bate says: “We’re wondering whether, if we could test children at, say, seven, there might be a chance that some training could help. It’s going to be an uphill battle but we do need those tests – just as they have them for dyslexia.”

A classic case is former IT teacher Jo Livingston, 67, from Bexley. She suffers from the condition and, having retired, is now touring schools and giving talks to make people aware of the problem. Even now, she only recognises her husband “because he has a beard and talks a lot”. They met in their 20s as members of a climbing club.

She says: “When you’re climbing you always wear the same clothes and if someone wears a red anorak they’ll be in a red anorak next week. So I married the one in the red anorak because that was the one I was looking for. Now I do the talks so that people can know about it – so they can have that ‘that’s me’ moment.”

Livingston has found instances where a woman could only be sure it was her baby in hospital if it was the one with a cuddly toy in the cot. Another woman said she was at a festival, looking for someone she’d planned to meet and only later found she’d been chatting to Ronan Keating. And a Hollywood engineer couldn’t even recognise Brad Pitt when they shared a lift.

“Television’s very difficult because characters change clothes and hairstyles and sometimes the plot hinges on that,” Livingston says. “You see two young blond women and you think they’re the same person until they appear on screen together and then you mentally have to rewrite the entire plot. It’s quite exhausting.”

Another sufferer is social worker Nerina Parr, 44, from Brighton. She says: “It’s the new dyslexia… nobody could explain what it was and half the time they didn’t have any sympathy with it anyway. It’s always getting me into trouble. For instance, my partner changed the picture of us on my bedside and I got really jealous and demanded to know who this new person was… then there’s the nightmare of walking into work meetings and not knowing who the people are – even though you work with them.”

Anna Cady, a 60-year-old artist from Winchester, thought at one stage that she had Alzheimer’s or dementia. “So when I found out what it was it was a tremendous relief. Then again, I did some tests on the internet and ended up sobbing my eyes out because I couldn’t even tell when they changed the faces. The awful thing is that you dread going outside because you might offend someone by not recognising them. When someone says ‘hello, Anna’ your heart sinks because you just hope you aren’t going to offend someone.”

If you think you have face blindness and would like to be part of the research you can register at prosopagnosiaresearch.org

Face blindness: Causes and cures

Prosopagnosia or face blindness can be caused by stroke or brain injury, but some people are born with it or develop it despite having no other signs of brain impairment. Recent research suggests it may sometimes be genetic.

It is thought to be caused by abnormality of or damage to a part of the brain that controls memory and facial perception.

In extreme cases, those with the condition are unable to recognise their own faces or tell the difference between a face and an object.

Treatment focuses on teaching coping strategies and the use of a variety of prompts and cues to recognise people by other means. But research is under way and it is hoped an effective prevention or cure may be found.